As most MMA fans know by now, Cat Zingano suffered an ACL injury and meniscus tear to her right knee, and underwent surgery on May 28 to repair the damage. This injury tanked her opportunity to coach on the upcoming season of The Ultimate Fighter. Both Cat and her husband Mauricio Zingano have been using social media to chronicle Cat's early recovery from injury. Needless to say, I really like that. Today, I will review Cat's injury and treatment thus far, as well as some of the challenges that female athletes face when it comes to ACL injuries.
The Mechanism of Injury
Cat's knee injury occurred during a training session, and she described how it happened for Yahoo! Sports:
"I was jumping over tunnels that were about 12 inches high. I'd jumped over them like 10 times already. This one time, I jumped up and my left knee came down right on track and my right knee bent outward."
So we see the injury was associated with the mechanics of her landing after performing a jump. Research points to the fact that female athletes participating in sports that include jumping and pivoting are 2 to 10 times more likely to sustain a knee ligament injury than their male counterparts [1, 2]. Numerous factors have been studied when trying to explain why females are at greater risk, including anatomical differences, overall degree of knee joint laxity, and hormonal differences. As one author desribes it , "The results of these studies have been mixed, and some of these factors, being static and unmodifiable, are less conducive to intervention." This is not to say that these factors do not contribute to the elevated risk of ACL injury- only that they are difficult to modify through some type of treatment or intervention.
There has also been much research on factors that can potentially be modified. When compared to males, females tend to have altered alignment of the legs when they land from a jump, causing the knee to buckle inward or outward. Buckling inward (or valgus stress) is especially risky for possible ACL injury. Females tend to land in a more upright position, with less knee and hip flexion . The ACL is under increased stress when landing with the knee in a more extended (ie, less flexed) position. Also, at least one study has shown that female athletes have lower activation of their hamstring muscles than males during athletic activities such as running and cutting . The hamstrings serve a dynamic protective function for the ACL by resisting anterior shearing of the tibia (lower leg bone) during athletic activities.
There is one interesting caveat with regard to the research on female athlete ACL injuries. None of the research that I have found was specific to females participating in MMA. Rather, the research (understandably) involves more traditional sports, such as volleyball and soccer. It will be interesting to see if there are more ACL injuries amongst female MMA athletes compared to males over time, especially as the popularity of WMMA increases.
The good news is that specific training regimens have been shown to reduce the risk of ACL injury for female athletes. Training programs that incorporate lower extremity neuromuscular control, plyometric training and training on proper, safe landing patterns can be effective at reducing the risk of ACL injury.
Zingano's Early Post-Operative Treatment
On May 29, Cat Tweeted a picture of herself using a continuous passive motion (CPM) device.
Cat Zingano (@CatZingano) May 29, 2013
This device is used to gradually and safely restore mobility to the knee, while at the same time avoiding active muscle contraction to obtain the range of motion. Passive motion will help to lessen the likelihood of adhesions, reduce edema, and reduce or control pain. Passive motion may also help to promote soft tissue healing in the immediate post-operative phase.
Cat's husband Mauricio Zingano Tweeted a video of Cat using a device on her knee that provides pneumatic (air) compression and cold therapy simultaneously. (The brand name is Game Ready.)
Cat Zingano ACL surgery recovery youtu.be/w0fHKkqAg-w— Mauricio Zingano (@zinganobjj) June 1, 2013
This treatment can help in reducing pain and edema at the knee. It can also help to control soft tissue inflammation and possibly aide the healing process of the soft tissue. (I have personally used this device. It feels awesome on a painful knee.)
At this time, Cat is spending a lot of time in bed between using the CPM and the pneumatic compression devices. The primary goal at this point is to control swelling of the knee and restore full range of motion. I hope we see Cat back in the Octagon sometime in early 2014.
- Hewett, TE. Why women have an increased risk of ACL injury. AAOS Now. November 2010. http://www.aaos.org/news/aaosnow/nov10/research3.asp Accessed June 1, 2013.
- Voskanian, N. ACL injury prevention in female athletes: review of the literature and practical considerations in implementing an ACL prevention program. Curr Rev Musculoskelet Med. 2013 Jun;6(2):158-163.
- Barber-Westin SD, Noyes FR et al. Reducing the risk of noncontact anterior cruciate ligament injuries in the female athlete. Phys Sportsmed. 2009;37:492-501.
- Malinzak, RA, Colby SM et al. A comparison of knee joint motion patterns between men and women in selected athletic tasks. Clin Biomech. 2001;16:438-445.